血浆N-末端脑钠肽前体（NT-proBNP）水平与冠状动脉病变程度的相关研究
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摘要
目的：分析稳定型心绞痛、不稳定型心绞痛和急性心肌梗死患者中的血浆N-末端脑钠肽前体水平,研究血浆N-末端脑钠肽前体水平与冠状动脉造影证实的冠状动脉病变严重程度之间的关系及可能的临床意义。
对象和方法：选取2011年1月至2012年1月期间入住济南市第三人民医院心内科的82例患者入选本研究。依据患者临床表现、心电图及心肌损伤标记物分为三组：稳定型心绞痛组(SA,n=23例)、不稳定型心绞痛组(UA,n=28例)、急性心肌梗死组(AMI, n=31例)。82例患者入院后均行冠状动脉造影及冠脉狭窄程度的评分(Gensini评分),同时选20例与研究组年龄、性别相匹配,因胸痛就诊但冠状动脉造影正常的患者作为正常对照组。所有入选本研究的患者均于入院后行冠状动脉造影,冠状动脉狭窄与否和狭窄程度通过目测法来判定。根据冠状动脉造影结果进一步将冠脉狭窄组分为一支病变组(n=22例),二支病变组(n=31例),三支病变组(n=29例)以及前降支病变组(n=8例)、回旋支病变组(n=5例)和右冠状动脉病变组(n=8例)。并在行冠状动脉造影前晨起从周围静脉中留取血样本,本研究采用电化学发光法测定血浆NT-proBNP水平,严格按试剂规定方式操作,分别检测冠心病各组与对照组,以及冠状动脉不同病变支数、不同病变部位的血浆NT-proBNP水平,并进行Gensini评分及TIMI血流评分,同时检测急性心肌梗死组cTnI水平。采用SPSS17.0统计软件进行统计学分析。所有计量资料用均数±标准差表示,两个样本的均数检验使用t检验,多个样本的均数检验采用方差分析,相关性检验采用spearman相关分析。P<0.05为差异有显著性意义。
结果：
1.AMI组血浆NT-proBNP水平明显高于UA组、SA组和对照组,UA组血浆NT-proBNP明显高于SA组和对照组,SA组血浆NT-proBNP高于对照组,差异均有统计学意义(p均<0.05)。
2.在冠心病患者中,三支病变组的血浆NT-proBNP水平高于二支病变组和一支病变组,差异均有统计学意义,P分别<0.05和<0.01。
3.AMI组的血浆NT-proBNP水平与cTnI水平呈正相关,结果有统计学意义(r==0.895,p<0.01)。
4.前降支病变组的血浆NT-proBNP水平明显高于右冠脉病变组和回旋支病变组,差异亦均有统计学意义,P均<0.01。
5.冠心病患者血浆NT-proBNP水平与Gensini积分呈正相关(r==0.963,p<0.01),与TIMI血流评分呈负相关(r=-0.39,P<0.01),结果均有统计学意义。
结论：
1.冠心病患者的血浆NT-proBNP水平显著增高,提示血浆NT-proBNP水平可用于预测心肌缺血的严重程度。
2.冠脉病变支数越多,犯罪血管越重要,血浆NT-proBNP水平越高,提示血浆NT-proBNP水平可用于预测冠状动脉病变的严重程度。
3.急性心肌梗死患者血浆NT-proBNP水平与cTnI水平明显正相关,提示血浆NT-proBNP水平可作为预测AMI中心肌缺血的严重程度,可提示作为重要的诊断指标之一。
4、血浆NT-proBNP水平与Gensini评分有呈正相关,与TIMI血流评分呈负相关,提示NT-proBNP升高越明显,心肌缺血越严重。
5.血浆NT-proBNP水平对冠心病患者危险评估有一定价值。
Objective:To evaluate plasma NT-proBNP levels in patients with stable angina unstable angina or acute myocardial infarction, and to investigate the relationship between the NT-proBNP levels and the severity and extent of involved coronary vessels.
Objects and Methods:82patients with coronary heart disease patients enrolled in this study. According to clinical manifestation, electrocardiography and the levels of biochemical markers of myocardial necrosis, they were classified into3groups: stable angina group(SA, n=23), unstable angina group(UA, n=28)and acute myocardial infarction group(AMI, n=31).82subjects who underwent coronary angiography and calculated Gensini score. We compared these groups with20cases gender-matched cases who complained of chest pain and with negative CAG result. CAS group was divided into single-vessel(n=22), double-vessel(n=31)and triple-vessel group(n=29). Group n=8cases, the circumflex branch of anterior descending artery lesions n=5cases of the disease Group and the group n=8cases of right coronary artery lesions. Coronary angiography and good leave from the peripheral venous blood samples before analysis of the enzyme-linked immunosorbent assay method for the determination of plasma levels of NT-proBNP. All data processing were done using SPSS17.0statistical package. Measurement data expressed using mean±standard deviation, the two groups were compared using the t-test, multi-group comparison done using analysis of variance. Gensini and NT-proBNP level score, the level of cTnI and TIMI bleeding score between relevant inspection, Analysis of Selecting Spearman correlation coefficient. P<0.05differences have a significant mean.
Results:
1. The level of NT-proBNP was significantly higher in AMI groups than in other three groups(P<0.05), and was marked higher in UA than in SA Por control(P<0.05), also was higher in SA than in control groups(P<0.05).
2. Among patients AHD, plasma NT-proBNP concentrations in patients with three-vessel was higher than those of patients with two-vessel and single vessle, P<0.05. P<0.01.
3. In AMI group had a significant correlation between the level of NT-proBNP and troponin I(cTnI)(r=0.895, p<0.01).
4. Plasma NT-proBNP concentrations in patients with left anterior descending coronary artery(LAD) was higher than those of patients with right coronary artery(RCA) and left circumflex coronary artery (LCX). P<0.01.
5. With the comparison and analysis between the level of NT-proBNP and Gensini Score (r=0.963, p<0.01), we found the level of NT-proBNP tended to increase with the aggravation of coronary artery stenosis. TIMI flow showed a signal ficant negative correlation with plasma NT-proBNP levels(r=-0.39, P<0.01).
Conclusion:
1. Plasma NT-proBNP significantly increased in patients with coronary heart disease, prompting level of plasma NT-proBNP can be used to predict the severity of myocardial ischemia.
2. Support the greater the number of coronary artery lesion, vascular the more important crimes, the higher the level of plasma NT-proBNP, prompting level of plasma NT-proBNP can be used to predict the severity of coronary artery disease.
3. NT-proBNP levels in patients with acute myocardial infarction associated with the level of cTnI clearly working, prompting level of plasma NT-proBNP as a severity prediction of myocardial ischemia.
4. The level of plasma NT-proBNP and Gensini score is positive, and TIMI bleeding score is negative, the more obvious tips NT-proBNP rise, the more severe myocardial ischemia.
5. The levels of Plasma NT-proBNP have some value on risk assessment in patients with coronary heart disease.
对象和方法：选取2011年1月至2012年1月期间入住济南市第三人民医院心内科的82例患者入选本研究。依据患者临床表现、心电图及心肌损伤标记物分为三组：稳定型心绞痛组(SA,n=23例)、不稳定型心绞痛组(UA,n=28例)、急性心肌梗死组(AMI, n=31例)。82例患者入院后均行冠状动脉造影及冠脉狭窄程度的评分(Gensini评分),同时选20例与研究组年龄、性别相匹配,因胸痛就诊但冠状动脉造影正常的患者作为正常对照组。所有入选本研究的患者均于入院后行冠状动脉造影,冠状动脉狭窄与否和狭窄程度通过目测法来判定。根据冠状动脉造影结果进一步将冠脉狭窄组分为一支病变组(n=22例),二支病变组(n=31例),三支病变组(n=29例)以及前降支病变组(n=8例)、回旋支病变组(n=5例)和右冠状动脉病变组(n=8例)。并在行冠状动脉造影前晨起从周围静脉中留取血样本,本研究采用电化学发光法测定血浆NT-proBNP水平,严格按试剂规定方式操作,分别检测冠心病各组与对照组,以及冠状动脉不同病变支数、不同病变部位的血浆NT-proBNP水平,并进行Gensini评分及TIMI血流评分,同时检测急性心肌梗死组cTnI水平。采用SPSS17.0统计软件进行统计学分析。所有计量资料用均数±标准差表示,两个样本的均数检验使用t检验,多个样本的均数检验采用方差分析,相关性检验采用spearman相关分析。P<0.05为差异有显著性意义。
结果：
1.AMI组血浆NT-proBNP水平明显高于UA组、SA组和对照组,UA组血浆NT-proBNP明显高于SA组和对照组,SA组血浆NT-proBNP高于对照组,差异均有统计学意义(p均<0.05)。
2.在冠心病患者中,三支病变组的血浆NT-proBNP水平高于二支病变组和一支病变组,差异均有统计学意义,P分别<0.05和<0.01。
3.AMI组的血浆NT-proBNP水平与cTnI水平呈正相关,结果有统计学意义(r==0.895,p<0.01)。
4.前降支病变组的血浆NT-proBNP水平明显高于右冠脉病变组和回旋支病变组,差异亦均有统计学意义,P均<0.01。
5.冠心病患者血浆NT-proBNP水平与Gensini积分呈正相关(r==0.963,p<0.01),与TIMI血流评分呈负相关(r=-0.39,P<0.01),结果均有统计学意义。
结论：
1.冠心病患者的血浆NT-proBNP水平显著增高,提示血浆NT-proBNP水平可用于预测心肌缺血的严重程度。
2.冠脉病变支数越多,犯罪血管越重要,血浆NT-proBNP水平越高,提示血浆NT-proBNP水平可用于预测冠状动脉病变的严重程度。
3.急性心肌梗死患者血浆NT-proBNP水平与cTnI水平明显正相关,提示血浆NT-proBNP水平可作为预测AMI中心肌缺血的严重程度,可提示作为重要的诊断指标之一。
4、血浆NT-proBNP水平与Gensini评分有呈正相关,与TIMI血流评分呈负相关,提示NT-proBNP升高越明显,心肌缺血越严重。
5.血浆NT-proBNP水平对冠心病患者危险评估有一定价值。
Objective:To evaluate plasma NT-proBNP levels in patients with stable angina unstable angina or acute myocardial infarction, and to investigate the relationship between the NT-proBNP levels and the severity and extent of involved coronary vessels.
Objects and Methods:82patients with coronary heart disease patients enrolled in this study. According to clinical manifestation, electrocardiography and the levels of biochemical markers of myocardial necrosis, they were classified into3groups: stable angina group(SA, n=23), unstable angina group(UA, n=28)and acute myocardial infarction group(AMI, n=31).82subjects who underwent coronary angiography and calculated Gensini score. We compared these groups with20cases gender-matched cases who complained of chest pain and with negative CAG result. CAS group was divided into single-vessel(n=22), double-vessel(n=31)and triple-vessel group(n=29). Group n=8cases, the circumflex branch of anterior descending artery lesions n=5cases of the disease Group and the group n=8cases of right coronary artery lesions. Coronary angiography and good leave from the peripheral venous blood samples before analysis of the enzyme-linked immunosorbent assay method for the determination of plasma levels of NT-proBNP. All data processing were done using SPSS17.0statistical package. Measurement data expressed using mean±standard deviation, the two groups were compared using the t-test, multi-group comparison done using analysis of variance. Gensini and NT-proBNP level score, the level of cTnI and TIMI bleeding score between relevant inspection, Analysis of Selecting Spearman correlation coefficient. P<0.05differences have a significant mean.
Results:
1. The level of NT-proBNP was significantly higher in AMI groups than in other three groups(P<0.05), and was marked higher in UA than in SA Por control(P<0.05), also was higher in SA than in control groups(P<0.05).
2. Among patients AHD, plasma NT-proBNP concentrations in patients with three-vessel was higher than those of patients with two-vessel and single vessle, P<0.05. P<0.01.
3. In AMI group had a significant correlation between the level of NT-proBNP and troponin I(cTnI)(r=0.895, p<0.01).
4. Plasma NT-proBNP concentrations in patients with left anterior descending coronary artery(LAD) was higher than those of patients with right coronary artery(RCA) and left circumflex coronary artery (LCX). P<0.01.
5. With the comparison and analysis between the level of NT-proBNP and Gensini Score (r=0.963, p<0.01), we found the level of NT-proBNP tended to increase with the aggravation of coronary artery stenosis. TIMI flow showed a signal ficant negative correlation with plasma NT-proBNP levels(r=-0.39, P<0.01).
Conclusion:
1. Plasma NT-proBNP significantly increased in patients with coronary heart disease, prompting level of plasma NT-proBNP can be used to predict the severity of myocardial ischemia.
2. Support the greater the number of coronary artery lesion, vascular the more important crimes, the higher the level of plasma NT-proBNP, prompting level of plasma NT-proBNP can be used to predict the severity of coronary artery disease.
3. NT-proBNP levels in patients with acute myocardial infarction associated with the level of cTnI clearly working, prompting level of plasma NT-proBNP as a severity prediction of myocardial ischemia.
4. The level of plasma NT-proBNP and Gensini score is positive, and TIMI bleeding score is negative, the more obvious tips NT-proBNP rise, the more severe myocardial ischemia.
5. The levels of Plasma NT-proBNP have some value on risk assessment in patients with coronary heart disease.
引文
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27 Pertlberton CJ, Johnson ML, Yandle TG,et al. Deconvolution analysis of cardiac natriuretie peptide during acute volume overload[J]. Hypertension,2000,36(3): 355.359
28 Januzzi JL, Camargo CA, Anwaruddin S, et al. The N-terminal pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardial, 2005; 95:948.954
29 anuzzi JL, vail Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short—term prognosis in acute destabilized heart failure:an international pooled analysis of 1256 patients:the International Collaborative of NT-proBNP Study. Eur Heart J,2006; 27:330-337
30 Bay M, Kirk V, Pamer J, et al. NT-proBNP:a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart,2003; 89:150-154
31 Harrison A, Morrison LK, Krishnaswamy P, et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med,2002; 39:131.138
32 Januzzi JL, vail Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure:an international pooled analysis of 1256 patients:the International Collaborative of NT-proBNP Study. Eur Heart J,2006; 27:330-337
33 Mueller T, Gegenhuber A, Poelz W, et al. Diagnostic accuracy of B-type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure. Heart,2005; 91:606-612
34 Toth M, Vuofinen KH, Vuolteenaho O, et al. Hypoxia stimulates release of ANP and BNP from perfused rat ventricular myocardium. Am J Physiol Heart Circ Physiol,1994; 266:H1572-1580
35 D'Souza SP,Yellon DM, Martin C, et al. B-type natriurefic peptide limits infarct size in rat isolated hearts via KATP channel opening Am J Physiol Heart Circ Physiol,2003; 284:H159-600
36 Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated witll myocardial ischemia. FASEB J.2003; 17:1105-1107
37 Goetze JP, Gore A, MollerCH, et al. Acute myocardial hypoxia increases BNP gene expression. FASEB J,2004; 18:1928-1930
38 Tateishi J, Masutani M, Ohyanagi M, et al. Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty. Clin Cardiol,2000; 23:776-780
39 Foote RS, Pearlman JD, Siegel AH, et al. Detection of exercise induced ischemia by changes in B-type natriuretic peptides. J Am Coll Cardiol,2004; 44: 1980-1987
40 MARUMOTO K, HAgADA M, HIWADA K. Increased secretion of atrial and brain natriuretic peptides during acute myocardial ischaemia induced by dynamic exercise in patients with angina pectoris[J]. Clin Sci(Colch),1995,88(5):551-556
41 SAHINARSLAN A, CENGEL A, OKYAY K, et al. B-type natriuretic peptide and extent of lesion on coronary angiography in stable coronary aItery disease[J]. Coron Artery Dis,2005,16(4):225-229
42 Kragelund C, Gronning B, Kober L, et al-N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med, 2005; 352:666-675
43 WIVIOTY S D, DE LEMOS J A, MORRO W D A. Pathophysi0109y, prognostic significance and clinical utility of B-type natriuretic peptide in acute coronary syndromes[J]. Clin Chim Acta,2004,346(2):119-128
44赵季红,陈少伯,柴小红,等。冠心病心绞痛患者血浆B型纳尿肽的临床意义[J].中国动脉硬化杂志,2005,13(5)：642-643
47 Jernberg T, Stridsberg M, Venge P, et al. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coil Cardi01.2002; 40:437-445
48 Heeschen C, Harem CW, Mitrovic V, et al。 N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients witll acute coronary syndromes. Circulation,2004; 110:3206-3212
49 Richards AM, Nicholls MG, Espiner EA, et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation,2003; 107:2786-2792
50王岚峰,吴双,关秀茹,等。脑钠素与急性心肌梗死预后关系的I插床研究。中华心血管病杂志,2005,33(3)： 234-237
51 Shimiju H, Murakami Y, Inou E s, et al. High plasma brain natriuretic polypeptide level as a market of risk for thromboembokism in patients with nonvaluclar atrial fibrillation[J]. Stroke,2002,33:1005-1010
52 Silet H, Youngxu Y, walleigh D, et al. Brain natriuretic peptide is elevated outpatients with atrial fibrillation[J]. Am J Cardiol,2003,92:1124-1127
53 Vinch s, Rashkin J, Logsetty G, et al. Brain natriuretic peptide levels fall rapidly after cardio version of atrial fibrillation to sinus ruythm[J]]. cardiology,2004,102: 188-93
54宿燕岗,何梅先,童步高,等.动态心房超速起搏治疗阵发性心房颤动[J]中国临床医学,2002,9(5)：486-489
55 Gerber IL, Stewart RA, Legget ME, et al. Increased plasmana iuretic eptide levels reflect symptom onset in aortic stenosis · Circulation,2003; 107:1884-1890
56 Bergler. Klein J, KLaar U, Heger M, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aorticstenosis. Circulation,2004; 109:2302-2308
57 Weber M, Arnold R, Rau M, et al, Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease. Eur Heart J,2005; 26:1023-1030
58 Yusoff R, Clayton N'Keevit B, et al. Utility of plasma N-terminal brain natriuretic peptide as a marker of functional capacity in patients with chronic severe mitral regurgitation. Am J Cardiol,2006; 97:1498-1501
59 Detaint D, Messika-Zeitoun D, Avierinos JF,et al. B—type natriuretic peptide in organic mitral regurgitation:determinants and impact on outcome. Circulation.2005; 111:2391-2397
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27 Pertlberton CJ, Johnson ML, Yandle TG,et al. Deconvolution analysis of cardiac natriuretie peptide during acute volume overload[J]. Hypertension,2000,36(3): 355.359
28 Januzzi JL, Camargo CA, Anwaruddin S, et al. The N-terminal pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardial, 2005; 95:948.954
29 anuzzi JL, vail Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short—term prognosis in acute destabilized heart failure:an international pooled analysis of 1256 patients:the International Collaborative of NT-proBNP Study. Eur Heart J,2006; 27:330-337
30 Bay M, Kirk V, Pamer J, et al. NT-proBNP:a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart,2003; 89:150-154
31 Harrison A, Morrison LK, Krishnaswamy P, et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med,2002; 39:131.138
32 Januzzi JL, vail Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure:an international pooled analysis of 1256 patients:the International Collaborative of NT-proBNP Study. Eur Heart J,2006; 27:330-337
33 Mueller T, Gegenhuber A, Poelz W, et al. Diagnostic accuracy of B-type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure. Heart,2005; 91:606-612
34 Toth M, Vuofinen KH, Vuolteenaho O, et al. Hypoxia stimulates release of ANP and BNP from perfused rat ventricular myocardium. Am J Physiol Heart Circ Physiol,1994; 266:H1572-1580
35 D'Souza SP,Yellon DM, Martin C, et al. B-type natriurefic peptide limits infarct size in rat isolated hearts via KATP channel opening Am J Physiol Heart Circ Physiol,2003; 284:H159-600
36 Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated witll myocardial ischemia. FASEB J.2003; 17:1105-1107
37 Goetze JP, Gore A, MollerCH, et al. Acute myocardial hypoxia increases BNP gene expression. FASEB J,2004; 18:1928-1930
38 Tateishi J, Masutani M, Ohyanagi M, et al. Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty. Clin Cardiol,2000; 23:776-780
39 Foote RS, Pearlman JD, Siegel AH, et al. Detection of exercise induced ischemia by changes in B-type natriuretic peptides. J Am Coll Cardiol,2004; 44: 1980-1987
40 MARUMOTO K, HAgADA M, HIWADA K. Increased secretion of atrial and brain natriuretic peptides during acute myocardial ischaemia induced by dynamic exercise in patients with angina pectoris[J]. Clin Sci(Colch),1995,88(5):551-556
41 SAHINARSLAN A, CENGEL A, OKYAY K, et al. B-type natriuretic peptide and extent of lesion on coronary angiography in stable coronary aItery disease[J]. Coron Artery Dis,2005,16(4):225-229
42 Kragelund C, Gronning B, Kober L, et al-N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med, 2005; 352:666-675
43 WIVIOTY S D, DE LEMOS J A, MORRO W D A. Pathophysi0109y, prognostic significance and clinical utility of B-type natriuretic peptide in acute coronary syndromes[J]. Clin Chim Acta,2004,346(2):119-128
44赵季红,陈少伯,柴小红,等。冠心病心绞痛患者血浆B型纳尿肽的临床意义[J].中国动脉硬化杂志,2005,13(5)：642-643
47 Jernberg T, Stridsberg M, Venge P, et al. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coil Cardi01.2002; 40:437-445
48 Heeschen C, Harem CW, Mitrovic V, et al。 N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients witll acute coronary syndromes. Circulation,2004; 110:3206-3212
49 Richards AM, Nicholls MG, Espiner EA, et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation,2003; 107:2786-2792
50王岚峰,吴双,关秀茹,等。脑钠素与急性心肌梗死预后关系的I插床研究。中华心血管病杂志,2005,33(3)： 234-237
51 Shimiju H, Murakami Y, Inou E s, et al. High plasma brain natriuretic polypeptide level as a market of risk for thromboembokism in patients with nonvaluclar atrial fibrillation[J]. Stroke,2002,33:1005-1010
52 Silet H, Youngxu Y, walleigh D, et al. Brain natriuretic peptide is elevated outpatients with atrial fibrillation[J]. Am J Cardiol,2003,92:1124-1127
53 Vinch s, Rashkin J, Logsetty G, et al. Brain natriuretic peptide levels fall rapidly after cardio version of atrial fibrillation to sinus ruythm[J]]. cardiology,2004,102: 188-93
54宿燕岗,何梅先,童步高,等.动态心房超速起搏治疗阵发性心房颤动[J]中国临床医学,2002,9(5)：486-489
55 Gerber IL, Stewart RA, Legget ME, et al. Increased plasmana iuretic eptide levels reflect symptom onset in aortic stenosis · Circulation,2003; 107:1884-1890
56 Bergler. Klein J, KLaar U, Heger M, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aorticstenosis. Circulation,2004; 109:2302-2308
57 Weber M, Arnold R, Rau M, et al, Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease. Eur Heart J,2005; 26:1023-1030
58 Yusoff R, Clayton N'Keevit B, et al. Utility of plasma N-terminal brain natriuretic peptide as a marker of functional capacity in patients with chronic severe mitral regurgitation. Am J Cardiol,2006; 97:1498-1501
59 Detaint D, Messika-Zeitoun D, Avierinos JF,et al. B—type natriuretic peptide in organic mitral regurgitation:determinants and impact on outcome. Circulation.2005; 111:2391-2397